tbuckley/cabot-search huggingface dataset:
Abstract 11343: Unique Phenotypes of Three-Dimensional Aortic Growth in Genetic Aortopathy
Authors: Nicholas S Burris, Yanglong Lu, Heather A Knuer, Gregory Spahlinger, Charles R Hatt
Journal: Circulation (2022)

Introduction: Patients with genetically-mediated thoracic aortic aneurysm (TAA) are at high risk of progressive aortic growth, although growth is highly variable and often difficult to accurately define using conventional diameter measurements. An emerging image analysis technique, vascular deformation mapping (VDM), provides accurate, three-dimensional (3D) mapping of aortic growth. Hypothesis: 3D growth mapping of the thoracic aorta will reveal unique patterns/phenotypes of growth in patients with genetically-mediated TAA. Material and Methods: We included adult (&gt;18) patients at our center with GM-TAA and at least 2 CT angiograms &gt;1 year apart. 3D aortic growth was measured by VDM. The longest CT interval with was used for analysis. Results: 61 patients (average follow-up 5.4 ± 3.6 years, cumulative 331 years) were included, with etiologies: Marfan (n=41), Loeys-Dietz (n=2), vascular Ehlers-Danlos (n=5), and familial TAA (n=13). Average age was 54.8 ± 16.6 years and 42.6% were female (n=26). The majority (n=38, 62%) had a history of open root/ascending aortic repair. Among post-surgical patients, three patterns emerged from VDM growth maps: 1) “One-and-done” - prior repair of diseased segment with no further aortic growth (n=14); 2) Adjacent segment - growth limited to native aortic segment adjacent to a surgically repaired segment (n=9); 3) Diffuse growth - significant growth involving all native aortic segments (n=15). Among non-surgical patients (n=23, 38%) there were similarly three growth patterns by VDM: 1) Stable - no growth (n=9); 2) Heterogeneous growth - multi-focal growth with intervening regions without growth (n=7); 3) Diffuse growth - contiguous growth involving all segments (n=7). Conclusion: Growth in genetic aortopathy is highly variable in extent and degree both before and after aortic repair. Unique phenotypes of 3D growth identified by VDM may have important implications for risk stratification and surgical planning.
Abstract 11096: Impact of Rhythm versus Rate Control in Atrial Fibrillation on All-Cause Mortality, Hospitalization and Stroke: A Systematic Review and Meta-Analysis
Authors: Ramzi Ibrahim, Abdulbaril Olagunju, Ali Moradi, Ayman R Fath, Nawfal Mihyawi, Beeletsega Yeneneh
Journal: Circulation (2022)

Introduction: Many randomized controlled trials (RCTs) compared rate control vs rhythm control therapy in patients with atrial fibrillation (AF). In this study, we systematically reviewed these RCTs and performed a meta-analysis of the outcomes comparing the two therapies. Methods: We searched PubMed, Medline, EMBASE, and SCOPUS databases until April 30, 2022 for all RCTs investigating AF rate vs rhythm control. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for constructing and reporting this review. We assigned I 2 &gt;50% as an indicator of statistical heterogeneity among the RCTs. We analyzed all-cause mortality, stroke rate, heart failure (HF) hospitalization, and total hospitalization between the two groups. We estimated the risk ratios (RR) with a random-effects model using the Mantel-Haenszel technique and calculated the 95% confidence intervals (CI). A P-value &lt;0.05 was considered significant. All analyses were performed using Review Manager 5.3. Results: Twenty-one RCTs comprising 11,547 patients (77% male) were included. Between the two therapy groups, there was no significant difference in all-cause mortality (RR 1.02 [0.90-1.16], P=0.75 ), HF hospitalization (RR 1.04 [0.83-1.32], P=0.72 ), or stroke rate (RR 1.15 [0.88-1.50], P=0.32 ). Nonetheless, rate control was associated with reduced total hospitalizations (RR 0.77 [0.64-0.94], P=0.01 ). (Figure 1) Conclusions: Atrial fibrillation rate control therapy has similar outcomes to rhythm control in terms of all-cause mortality, HF hospitalization, and stroke rates, but a lower rate of total hospitalizations. Findings are consistent with multiple prior studies showing noninferiority of rate control to rhythm control. Figure 1 - Forest plots highlighting the outcomes of both treatment strategies on AF: A) All-cause mortality, B) Heart failure hospitalization, C) Stroke, and D) Total hospitalization.
Abstract 11237: Dose Response and Long QT Genotype During Exercise Stress Testing in Children
Authors: Gregory Webster, Dana E Coons, Thomas Carberry, Stephanie F Chandler, Sara Cherny, Elli N Jacobson, Angela C Onorato, Kendra M Ward, Christina Laternser
Journal: Circulation (2022)

Introduction: Beta-blockers (BB) are first-line therapy for long QT syndrome (LQTS). Many physicians rely on repeated exercise stress tests (ESTs) to establish the optimal dose in each patient. Hypothesis: Increased BB dose is associated with a decrease in maximum heart rate, influenced by precision-medicine factors including genotype. Methods: Retrospective chart review of treadmill ESTs with the outcome variable “% predicted heart rate (HR)” = (maximum HR achieved/(220-age))*100. Genotype positive patients had pathogenic or likely pathogenic variants, re-adjudicated in 2022. Doses of BB other than nadolol were converted to nadolol equivalents using an established methodology. Results: We evaluated 345 ESTs in 132 LQTS patients (58% genotype positive) from 2003-21. The mean age at first EST was 12.5 years (standard deviation 4.0 years). Most patients were prescribed nadolol (59%) or atenolol (28%). When controlled for person-level fixed effects, we observed an inverse relationship between BB dose and % predicted HR. The dose-response slope was steeper in genotype positive patients than genotype negative patients (-4.8 vs. -3.3, Figure , p&lt;0.01). We observed mild decreases in blood pressure as BB dose increased, (mean 5 mmHg decrease in systolic blood pressure per 1 mg/kg increase in BB). However, neither maximum VO2 nor maximum respiratory exchange ratio were affected by increased BB dose (the slope of each was indistinguishable from 0 in person-level fixed effects models). Conclusion: In children with LQTS, genotype positive patients were more sensitive to BB than genotype negative patients. We developed a multivariate model to predict the dose of BB required to achieve therapeutic beta-blockade, conditional on individual patient demographics and genotype. The model may decrease the need for serial ESTs. BB dose did not affect maximum VO2 or respiratory exchange ratio, which is reassuring for children and adolescents with LQTS who exercise.
Abstract 11656: Preoperative Cardiac Risk Assessment for a Patient With an Intracardiac Shunt Undergoing Laparoscopic Surgical Intervention
Authors: Tanuj Gupta, Nader Jamaleddine
Journal: Circulation (2022)

Introduction: In this case, we discuss the intraoperative risk of air cardioembolic stroke in patients with intra-cardiac shunts undergoing laparoscopic surgery due to CO 2 insufflation of the abdomen in conjunction with provoked right-to-left shunting from anesthesia. Case Presentation: 27-year-old Female with Down Syndrome and asymptomatic VSD presented with abdominal pain. CT Abdomen performed revealed Acute Cholecystitis and patient was admitted for urgent laparoscopic cholecystectomy. Cardiology was consulted for preoperative risk assessment. Echocardiogram recommended and redemonstrated known VSD with predominant left-to-right shunting and occasional flow reversal (right-to-left) at baseline. Upon discussion with Anesthesia, the concern arose for anesthesia induced flow reversal of the shunt with a risk of possible paradoxical air embolism from CO 2 insufflation during laparoscopy. This concern was presented to the General Surgery team for consideration of conversion of procedure to open cholecystectomy. Open cholecystectomy was performed without complications. Discussion/Conclusion: Laparoscopic surgery requires CO 2 insufflation of the abdomen to cause pneumoperitoneum (Fig 1A), following which a gas embolism can result (Fig 1B). Consequently, in the absence of a pre-existing cardiac defect, patients can develop a pulmonary embolism (Fig 1C). However, individuals with right-to-left intracardiac shunting (Fig 1D), or Eisenmenger Syndrome, confer the additional risk of cardioembolic stroke (Fig 1E). In the preoperative assessment, right-to-left shunting is easily identified by TTE and managed accordingly. However, less intuitively, it can also occur transiently from the intraoperative use of certain anesthesia medications such as Propafol, which is known to decrease SVR. Therefore, if the evaluating clinician is unaware of this mitigated risk, it may go undetected, the result of which can be fatal.
Abstract 11323: Superior Vena Cava Endocarditis in a Patient With Sickle Cell Disease
Authors: Arindam Sharma, Rosa N. Cruz Torres, Arunima Sharma, Pajjuru Venkat, Jalal Vargha
Journal: Circulation (2022)

Introduction: Patients with sickle cell disease are at risk for many types of cardiac complications. We present a case of endocarditis of the superior vena cava (SVC) in a 22-year-old male with sickle cell disease. Case study: A 22 year old male with sickle cell disease presented to the hospital with 3 days of fever, night sweats, generalized body pains, vomiting and poor oral intake. 6 weeks ago, he had been admitted to an outside hospital for Methicillin related Staphylococcus aureus (MRSA) bacteremia. At that time an implanted venous access port in the patient’s chest was removed and 4 weeks of intravenous(iv) vancomycin were administered. He was admitted to the hospital for sepsis. Blood cultures were drawn which were positive for MRSA. A transesophageal echocardiogram revealed a large mobile vegetation in the SVC ( Fig. 1) The proximal end of the vegetation extended beyond the echocardiographic field of view, so a CT scan of the chest with contrast was performed (Fig. 2) This showed intraluminal filling defects in the distal SVC along with pulmonary emboli in the lower lobes of the lungs bilaterally. His antibiotics were changed to iv daptomycin and ceftaroline but he remained persistently bacteremic for 14 days. Therefore, removal of the SVC vegetation/thrombus was performed using AngioVac venous drainage cannula system. This was followed by resolution of bacteremia, and he was discharged from the hospital 9 days later. Conclusion: Echocardiographic evaluation of endocarditis should involve a comprehensive evaluation of all cardiac structures and not be limited to valves only. AngioVac venous drainage cannula system can be used to remove infected vegetations/thrombus.
Abstract 11516: Heart Failure Patient Experiences With a Visualized Patient-Reported Outcome Monitoring Tool to Facilitate Beta-Blocker Decision-Making in an N-of-1 Trial
Authors: Sabrina Mangal, Maryam Hyder, Hannah Curtis, Kate Zarzuela, Ian Kronish, Mathew S Maurer, Mark Lachs, Monika M Safford, Parag Goyal
Journal: Circulation (2022)

Introduction: Emerging evidence suggests that beta-blockers may not be efficacious in preventing mortality in patients with heart failure with preserved ejection fraction (HFpEF) and could worsen exercise capacity. HFpEF patients’ symptoms often overlap with medication side effects, making precise decision-making about the need for beta-blockers a challenge. Objective: Evaluate patient attitudes toward using a patient-reported outcome (PRO) monitoring tool to facilitate shared decision-making about beta-blocker use in an N-of-1 clinical trial. Methods: Eligible HFpEF patients taking a beta-blocker were recruited from a heart failure clinic. Patients alternated between taking and not taking their beta-blocker for 2-week periods, with dedicated titration time in-between. Data were ascertained through exercise assessments, weekly/bi-weekly online PRO surveys, and remote vital measurements. Average symptom scores on and off beta-blocker were presented in a visualized report to patients, intended to facilitate a discussion about continuing vs. discontinuing their beta-blocker. We interviewed patients about feedback on study procedures and agency for decision-making at baseline and study visits. Interviews were recorded and transcribed. Three study team members analyzed interviews using directed content analysis. Results: To date, 9 patients completed the intervention, and 28 interviews were completed. Most participants were female and White (89%) with an average age of 78. Participants reported that their visualized PRO results were aligned their experiences, which reinforced their use of the tool and agency in beta-blocker decision-making (Table). Conclusions: Patients found that the visualized report helped to facilitate beta-blocker shared decision-making. Future research should evaluate the utility of integrating longitudinal PRO monitoring tools into usual care to facilitate individualized decisions about medications.
Abstract 11239: Gender Disparities in the Utilization of Catheter-Directed Thrombolytic Therapy vs. Systemic Thrombolytic Therapy in Patients With Acute Pulmonary Embolism
Authors: Ayeshah Jalid, Muddasir Ashraf
Journal: Circulation (2022)

Introduction: Gender disparities in the utilization of catheter-directed thrombolytic (CDT) therapy vs. systemic thrombolytic (ST) therapy in patients with acute pulmonary embolism (PE) have not been studied before. Methods: Using the National Inpatient Sample database from 2012 to 2018, we identified all adult patients with acute PE who received any thrombolytic therapy. The primary outcome was the utilization of CDT vs. ST therapy in females compared to males. The secondary outcome was the mortality in females compared to males in all patients of acute PE who received any thrombolytic therapy. Results: We identified 45,950 patients who received CDT or ST therapy. The mean age was 59.7 years in females vs. 59 in males (p-value - .03). Males were more likely to have saddle PE (33% vs. 29%, p-value &lt; .01) and less likely to have vasopressor use (3% vs. 5%, p-value &lt; .01). Baseline characteristics are shown in Table 1. Females were less likely to have CDT vs. ST therapy on adjusted analysis (AOR - 0.85, p-value &lt; .01), as shown in Table 2. Females also had 27% higher in-hospital mortality than males in the entire cohort who received any thrombolytic therapy even after adjustment for age, race, comorbidities, and hospital factors (AOR - 1.27, p-value &lt; .01). CDT was associated with a 58% lower risk of in-hospital mortality than systemic thrombolytic therapy in the adjusted model (AOR - 0.42, p-value &lt; .01). Conclusion: Gender disparities exist in the utilization of CDT in patients of acute PE who receive thrombolytic therapy, with lower utilization in females than males, despite significantly reduced in-hospital mortality associated with CDT vs. ST therapy.
Abstract 11448: Feasibility and Septal Perforation Rates in Left Bundle Branch Area Pacing
Authors: Muhtashim Mian, Habib R Khan
Journal: Circulation (2022)

Introduction: Left Bundle Branch area Pacing (LBBaP) is gaining prevalence as a more physiologic alternative to conventional right ventricular pacing. Given limited literature on LBBaP, this retrospective study assessed feasibility and septal perforation rates following LBBaP. Methods: Procedure reports and electrophysiologic parameters were reviewed of patients that underwent LBBaP since 2019. Partial septal perforation was defined as any two of: a) reduction of impedance by 200 ohms b) increase in capture threshold by 50% and c) decrease in ventricular sensing by 50% during follow-up compared to approximately 1-week post pacemaker implant. Results: Since 2019, LBBaP was attempted in 168 patients and was successful in 102 (60.7 %), partial successful in 55 (32.7%) defined as QRS reduction of &gt;20ms and duration &lt;140ms, and unsuccessful in 11 (6.6%). QRS duration shortened or remained short after successful LBBaP compared to unsuccessful (113 vs 147 ms, p &lt; 0.001). Left ventricular ejection fraction was similar following successful LBBaP (p = 0.92). Five patients (3%) had potential septal perforation based on above criteria. Lead revisions were not arranged for these patients as pacing requirements were not high and it was clinically appropriate to continue 3 monthly observations in clinic. Conclusions: We report success rates of LBBaP recently adopted in a large tertiary center. In a medium-term follow-up, we show that changes in electrophysiologic parameters likely consistent with partial septal perforation may occur spontaneously in some patients (3% in our cohort) over time. Clinical significance of these changes and confirmation with imaging requires further study.
Abstract 11044: Neither Peak Donor Troponin Nor Donor Troponin Trends Adversely Impact Post-Transplant Outcomes in Pediatric Heart Transplantation
Authors: Shahnawaz Amdani, Alice Toll, Samantha Noreen
Journal: Circulation (2022)

Introduction: Cardiac troponin is utilized in decision making when considering a suitable donor for heart transplant (HT). To date, no pediatric study has assessed the impact of peak donor troponin or donor troponin trends on post-HT survival. Methods: All children in the Organ Procurement and Transplantation Network database undergoing HT in the U.S. from 2007 - 2020 and with donor troponin I levels recorded were included. Donors were divided into groups based on peak troponin value: Low (0-&lt;25%ile), Medium (25-&lt;75%ile), and High (&gt;75%ile); and on differences between first and last troponin: Increasing : &gt;20% increase, Persistently high : initial and final troponin high; Persistently low : initial and final troponin normal; Decreasing : &gt;20% decrease. Donor characteristics were compared and effects of donor troponin on graft survival were evaluated both unadjusted and after multivariable adjustment using Cox proportional hazards model. Results: Of 5569 HT, troponin levels were available for 4572 (82%) recipients. Compared to donors with Low and Medium troponin values, donors with High troponin values were older (median age 3 vs. 7 vs. 13 years), male (59.2 vs. 59.5 vs. 64.7%), White (50.3 vs. 52.4 vs. 55.5%), died from anoxia (33.5 vs. 41.1 vs. 48.9%), with ejection fraction ≤55% (4.2 vs. 6.4 vs. 8.7%) and receive cardiopulmonary resuscitation [CPR] (44.3 vs. 53.7 vs. 63.3%) (p&lt;.05 for all). Donors with Increasing and Persistently high troponin values were older, had lower ejection fraction and were more likely to receive CPR than those with Persistently low and Decreasing troponin (p&lt;.05 for all). Neither unadjusted (Figures A, B) , nor multivariable adjusted outcomes revealed any differences in graft survival post-HT based on peak troponin or troponin trends (Figure C, Table A) Conclusions: Donor troponin values do not predict post-transplant survival in children undergoing HT. Our study will allow for safe expansion of donor heart utilization in pediatric HT.
Abstract 11196: Germline Mutation in Plakophilin 2 and Associated Hypertrophic Cardiomyopathy: Clinical Debate of Nascent Pleomorphism and Pleotropism
Authors: Saarwaani Vallabhajosyula, bipul baibhav
Journal: Circulation (2022)

Introduction: Arrhythmogenic cardiomyopathy(ACM) is often not seen until adolescence or early childhood. Electric abnormalities usually precede the structural remodeling visible on cardiac imaging. Clinical case: 31-year-old male with asthma and hypertension presented to the ED with palpitations and was in atrial fibrillation with rapid ventricular response. He was treated with diltiazem and converted to sinus rhythm. TTE performed showed basal septal hypertrophy with hypercontractile LV. He was discharged on beta-blocker and anticoagulation. Few days after, he reported lightheadedness and syncopal spells after starting on beta-blocker therapy, and orthostatic by nature. ECG revealed sinus rhythm, left ventricular hypertrophy and inferolateral deep T wave inversions. Family history was revealing for HCM in father and grandmother, but no genetic conditions or sudden cardiac deaths. Stress TTE with diltiazem use showed no LVOT obstruction at rest or after exercise. Cardiac MRI revealed asymmetric basal septal hypertrophy with max thickness of 1.5 cm. Dynamic LVOT obstruction was seen with anomalous insertion of papillary muscle into mid-anterior portion of anterior mitral leaflet. LV was hypercontractile with EF 85%, and no evidence of fibrosis. RV was normal in size/function without abnormal wall motion. Holter monitoring was unremarkable. Cardiomyopathy/arrhythmia multigene panel testing surprisingly showed a heterozygous plakophilin-2(PKP2) pathogenic germline mutation c.1689-1G&gt;C, pathogenic for ARVC. Conclusion: Based on current guidelines, he would not have ACM and begs the question of management in patients with positive ACM genetics, but no ACM-related disease expression. The underlining question would be the clinical significance and evolution of such detected mutations, and given the current paucity in evidence, we share your enthusiasm in learning more about this patient’s future clinical trajectory.
Abstract 11547: Red Blood Cell Distribution Width as a Predictive Indicator for Readmissions in Patients With Pulmonary Hypertension
Authors: Akhil Jain, Harsha Sai Sreemantula, Rakin Rashid, AISHA SULTANA SHAIK, Sohiel Deshpande, Ibrahim Ahmed, Sri Sravya Sakhi Sakhineti, Utsav Aiya, Aisha Abdul Sattar, Mansi Naik, Bohdan Baralo, John Finley
Journal: Circulation (2022)

Introduction: Elevated red cell distribution width (RDW) has been established as a predictive biomarker in patients with pulmonary hypertension (PH). Its value in predicting readmission rates in PH is not fully understood. Methods: PH patients were retrospectively identified between 1/1/2016 and 12/31/2017 and divided into normal (11.5-14.5%) and elevated (&gt;14.5%) RDW. The primary outcome was 90-day readmission related to heart failure (HF) exacerbation, increased supplemental oxygen (O2) requirements, and systemic inflammatory response syndrome (SIRS). Kaplan Meier survival curves were developed for the probability of primary outcomes-related readmissions. Results: Index admissions (n=74) had 78.38% elevated RDW (n=58) and 21.62% normal RDW (n=16). Age, sex, race and comorbidities were matched between the 2 cohorts (Figure 1). Of these, 70.3% (n=52) had readmissions in 90-days; 67.2% (n=39) with elevated RDW and 81.2% (n=13) with normal RDW. Log-rank p for 90-day readmission probability for HF exacerbation, increased O2 requirement and SIRS were statistically non-significant 0.945, 0.0931, and 0.351 respectively (Figure 2). Conclusions: Our findings do not support RDW alone as a predictive biomarker for readmission in patients with PH, albeit in a small sample size. This study could be viewed as a hypothesis-generating research to spawn further larger studies.